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Therapeutic Garden Design


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Therapeutic Garden Design ~ ASLA Spring 2006
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Therapeutic Garden Design

  1. 1. THERAPEUTIC GARDEN DESIGN AN ASLA PROFESSIONAL INTEREST GROUP IN THIS ISSUE: ■ Letter from the Co-Chairs ■ Design Practices Survey ■ Obtaining Funding ■ Design for a Memory Garden ■ Master Planning ■ Design for a Healing Garden THERAPEUTIC GARDEN DESIGN Mark Epstein, Co-chair Naomi Sachs, Co-chair Spring 2006 LETTER FROM THE CO-CHAIRS GREETINGS, For over twenty years, the message has remained the same. Almost a generation has passed with some, but not enough, change to health care environmental design known to provide benefits to staff, patients and visitors. In the chapter “Environmental Factors Affecting Inpatient Stress in Acute Care Hospitals,” (Environmental Stress Gary Evans, ed., 1982), Sally Ann Shumaker and Janet Reizenstein discuss key elements that we are still calling for today. These include control over one’s physical and psychological envi-ronment, social support, and interaction with nature. Given the increas-ing evidence for benefits of therapeutic gardens, why are more not being built? Advances have been made within hospital buildings. The benefits to patients that arise from the control of privacy, accommodation for family overnight stays, clear signs and unambigu-ous Given the increasing evidence for benefits of therapeutic gar-dens, not being built? wayfinding cues, physical comfort, and why are more positive symbols of the physical environment have been internalized by the healthcare design community and are being expressed in many new health care delivery facilities. Most health care companies now embrace and promote patient-centered care. Many resources are invested to ensure that the lighting, color, art-work, and atmosphere of the building benefit— or at least do no harm to— patients, visitors and staff. Some healthcare facilities are realizing that the outdoor space is important too. Mardelle Shepley, Director of the Center for Health Systems and Design at Texas A & M University, has stated that anyone who builds a healthcare facility now is concerned with providing access to nature. Yet most exteriors, even of new facilities, are still too often over-looked or treated as amenities—window-dressing rather than integral, productive spaces for health care delivery. Many of these outdoor spaces do not provide meaningful access to nature and do nothing to promote the mission of their facilities. Inside this issue you’ll find examples of facili-ties in Washington DC, Oregon, and Virginia where the grounds were given more considera-tion. An important part of the design process for hospitals and clinics is interviews with the facility staff—the people who have to work in and adapt to the design of the building. Staff interviews are customary in architectural scopes of work for healthcare facilities, and they should be a routine item in the contracts for landscape architects as well. It’s a well-worn phrase but worth repeating: landscape architects should be integral in the planning phase of the project, in some cases even before architects are hired to plan the buildings. The benefits that result from good site planning cannot be overstated. What about funding a therapeutic garden? Many healthcare gardens are not included in capi-tal budgets and must find other funding sources. Connie Roy-Fisher offers some useful ideas and recounts a successful grassroots campaign at a Florida medical center. Lastly, successful therapeutic gardens rely on verifiable evidence that the design of the space has some benefit to human well-being. We need studies of built gardens to evaluate how and why they’re being used so that designers and health care providers can avoid negative conse-quences and maximize the benefit to the garden user. Professor Jean Kavanagh will be undertak-ing the first nationwide survey of design elements in therapeutic gardens this summer, and she needs your help. Please consider join-ing this effort to provide valuable practical data for all of us to use on future projects. Best Regards, Mark Epstein, ASLA, and Naomi Sachs, ASLA, Co-chairs of the Therapeutic Garden Design Professional Practice Network AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■
  2. 2. 2 THERAPEUTIC GARDEN DESIGN: Spring 2006 FIELD SURVEY OF DESIGN DETAIL PRACTICES IN THERAPEUTIC GARDENS: CONNECTING DESIGN AND EFFECT Jean Kavanagh, FASLA The first nationwide field survey of design elements in therapeutic gardens will begin in summer 2006. Professor Jean Kavanagh, FASLA, has developed this web-based study to determine if designed elements and details in therapeutic gar-dens are actually performing as intended. She is seeking the participation of professionally designed therapeutic gardens of all sizes and from all regions of the United States. The survey will extend over a two-year period, from July 2006 through July 2008. During the two years, one survey question addressing garden use will be e-mailed bi-weekly to each therapeutic garden site representative. One hundred therapeutic garden representatives then will observe and report how garden visitors actually use each garden at a given hour on a given day throughout the country. With an estimated 25 questions possible each year, this study is expected to amass nationwide data examining how and which design features influence out-comes in therapeutic gardens of all types. All questions will inquire into the design and effect relationship between observed patterns of visitor activity and a specific design detail, element, or principle. Site observation and web-based data reporting can be accomplished by people with little or no design training and is expected to entail a little over one hour every two weeks. Landscape architects are encouraged to include their therapeu-tic garden projects in this survey. Those interested in joining or in learning more about the Connecting Design & Effect sur-vey can contact Jean Kavanagh or visit the study website at Jean Kavanagh, FASLA is Associate Professor of Landscape Architecture at Texas Tech University. She can be reached at 806-742-2858 or FUNDING HEALING GARDENS Connie Roy-Fisher, ASLA The implementation of a healing garden hinges on a funda-mental factor that makes the project possible: funding. Obtaining funding is not as difficult as it may seem. Besides typical capital budgets, there are several funding sources that can be tapped, such as donors, grants, fundraising campaigns and corporate sponsorships. Where to Begin The project begins with a vision and champions. The most successful projects result from collaboration between health-care facility administration and staff, patients, caregivers and design professionals. Start by considering how a garden proj-ect can help to achieve the goals of the healthcare facility and result in better outcomes. Gardens provide additional venues for a variety of therapies, attractive areas for staff to reduce stress, and comfortable settings for fundraising and communi-ty healthcare events. Working with a landscape architect, a conceptual plan can delineate garden size, features and costs. Once a concept is hatched, it is amazing how funding sources begin to appear. An initial starting point for the project can be allocating funds from the capital budget. Because there are no sales programs for healing gardens and healthcare staff are usually too busy to consider such amenities, projects like these are often over-looked when yearly budgets are being considered. A champion within the healthcare facility can present the idea for the gar-den and its benefits. These projects make up a small percentage of the budget when compared to the cost of other major capital expendi-tures. There is considerable return on this small investment that provides alternate therapy modalities, benefits staff and caregivers, and improves public relations. In the long run, returning clients will offset the initial investment. At a mini-mum, the capital budget can fund professional design fees to develop the concept into a preliminary or conceptual plan or sketches. Once the idea seed is planted in a drawing or sketch, it will grow into other forms of support. Donors are attracted to projects that can have a lasting, positive impact on the health-care campus. The Jacqueline Fiske Healing Garden at Jupiter Medical Center and the Cancer Memorial Garden at Good Samaritan Hospital were funded by single donors. Often donors get involved in the planning phase; this can be important to establish a sense of security in their investment or donation. The Fiskes were involved with the details of the garden and because of their donation and support, the garden actually included much more than the initial concept. The planning process familiarizes potential financiers with the built product, and can establish a sense of security in their investment and encourage donors to consider the long-term effects on the project. The Fiskes also donated money for an endowment to maintain the garden in perpetuity. One of the stipulations of their donation was that changes to the garden could not be made without approval of Jacqueline Fiske, her daughter and when she comes of age, her granddaughter. This approach ensured that the garden would be a lasting legacy for the Fiske family. Besides construction costs and maintenance funding, donors can consider funding programs within the garden, including horticultural therapy and education programs, to reap maxi-mum benefits from their garden investment. Grants Once a preliminary concept is on paper, grant applications can be filed for construction and programming. There are many grants available that will fund all or portions of the gar-den project. The main focus of a patio at the Pavilion Nursing Home at Jupiter Medical Center was a severely eroded reten-tion pond that overlooked the hospital parking lot. The AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■
  3. 3. 3 THERAPEUTIC GARDEN DESIGN: Spring 2006 Pavilion applied for a grant to “improve water quality” which funded planting, bird habitat creation, and an aerating foun-tain. It is important to think of projects outside the healing garden envelope when looking for grant opportunities. Funding Campaigns Group Donor participation is another possibility for funding a garden project that allows employee or community groups to fund a project. The Johnny Appleseed program at the Jupiter Medical Center raised $17,000 from employee donations and funded a major portion of a rehabilitative garden. The well thought out program resulted in 15% employee participation. The Johnny Appleseed program began with baskets of apples distributed around the hospital campus to announce the pro-gram. A kickoff meeting described the healing garden project to potential employee donors. Contribution forms invited participation through payroll deductions or a one-time gift. All donors received a thank you letter from the foundation for tax purposes, and name recognition in the garden. The success of the campaign was celebrated with an apple pie and cinnamon ice cream party. Donors were given an apple pin in recognition of their support. Corporate Sponsorships Some large corporations such as Home Depot and Wal-Mart make grant contributions to the community if they meet certain criterion. For example, The Home Depot supports 501(c)(3) tax-exempt nonprofit organizations with grants up to $3000. Wal-Mart has a grassroots style of giving which enables them to identify and support organizations that are improving the quality of life in their local communities by distributing matching funds (up to $1000), and direct grants. Pulling it all together By using one or a combination of the methods of funding described above, a garden project can become a reality. Encourage your clients to commit their vision to an initial design. It is amazing how funds become available once the project is defined. Connie Roy Fisher, ASLA is principal of Roy-Fisher Associates in Tequesta, Florida. Her firm’s mission is to foster a connection between natural elements, the senses, the psyche, and the soul through carefully detailed, sustainable projects that restore the landscape and the people that live in it. She can be reached at THE MEMORY GARDEN AT LAKEWOOD MANOR Nathan Gruver, Associate ASLA Lakewood Manor is a 128-acre active adult and senior living center located in Henrico County, Virginia, near Richmond. The client, Virginia Baptist Homes, contracted with SFCS Architects and Timmons Group landscape architects to update their facility to reflect the wants and needs of today’s senior housing market. The new additions will include fourteen single family cottages in a neighborhood setting, three apartment-style villas, a large recreation area, and a new health services wing complete with an outdoor courtyard, titled the “Memory Garden,” for Alzheimer’s and dementia patients. Construction and planting of the Memory Garden are scheduled to be completed by summer 2006. Our goal as designers of these restorative landscapes was to improve overall quality of life by creating a space that would engage the residents’ five senses in a safe and pleasant environ-ment. The creation of a Memory Garden in a relatively small space (5,700 square feet) presented design and materials challenges. In addition to the challenges common to most design and construction projects such as budget constraints, maintenance concerns, and project design control, this project entailed design issues common to many healthcare projects, namely addressing the specific needs of the users, from safety through improved quality of life issues, based on existing research. The premise of the Memory Garden was based on the impor-tance of earliest memories and how they are inevitably tied to the world outside. Many of the experiences we have as children, such as the first time we watched a butterfly flutter or a hummingbird dance in the air, may remain with us the rest of our lives. As we continue to grow, we learn to expand Example of Group Donor participation form AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■
  4. 4. THERAPEUTIC GARDEN DESIGN: Spring 2006 10 Site Development Residential Infrastructure Technology “THE MEMORY GARDEN” AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■ 4 Memory Garden site plan these interactions to other senses—perhaps taking shelter under a shade tree, pausing briefly to listen to the grasses rustle or reaching down to touch the water of a nearby brook to test the temperature with a quick splash. The body and mind’s senses can result in an attachment to moments in time when we laughed, smiled and found a way to put everything aside and relax in a peaceful environment, if even for a moment. The Garden is comprised of many elements to help aid the users’ recollections of past experiences. From inside the door of the health services building, visitors can walk out onto the “front porch” to view and hear Hazel’s fountain. The gardens are planted with colorful, fragrant, non-toxic perennials, annuals, and shrubs that provide interest during all four seasons. From the colorful benches visitors can see and hear birds, and can watch squirrels running along the top of the white picket fence. The fence keeps patients within the garden, in view of the staff, without feeling confining or prison-like. A pergola with raised planters offers visitors the ability to garden, or at least dig their hands into the rich black soil. Residents can grow the plants that they grew at home, providing a sense of continuity in their lives. These sensory elements are designed to reconnect residents to some of their favorite memories, and to facilitate positive experiences in the here and now. The Memory Garden was the sole portion of the project relying on private donations. In order to raise money for its construction, the owners proactively came up with the fundraising idea of inscribing brick pavers with the name of project donors. The brick pavers would be used in the walk-ways of the Garden. While the project design team applauded the fundraising idea, two design concerns became apparent. First, the selected pavers were to be inscribed in black writing. Research has indicated that complex patterns and shadows along walking surfaces can be confusing to sensory-impaired individuals, who sometimes mistake the writing for an object on the ground, or a change in grade. Would the bricks cause undue stress, or be a tripping hazard, to Garden visitors? The second design issue was the beveled edge on the pavers. This edge type was selected because it would potentially reduce breakage during shipping, and it holds in the sand to lock the units tightly together. The design team was concerned that the subtle channel between the pavers could be a tripping hazard and an obstacle for walkers or wheelchairs. We did not want to replace the bricks with concrete as in the other courtyards within the facility. Concrete should be used rarely, partly because of its cold colors and lack of texture. We wanted to keep intact more familiar surfaces and memories © 2004 Timmons Group. All rights reserved. TIMMONS GROUP YOUR VISION ACHIEVED THROUGH OURS. 1 2 3 4 5 6 7 8 9 11 12 13 14 1. Rose Trellis 2. Meditation Lawn 3. Garden Pergola with Raised Planters 4. Shade Tree 5. White Picket Fence 6. Hummingbird Garden 7. Color Coordinated Benches 8. Old Fashion Perennials 9. Hazel’s Fountain 10. Front Porch 11. Butter y Garden 12. Shade/Azalea Garden 13. Central Gathering Lawn 14. Circular Walking Path
  5. 5. THERAPEUTIC GARDEN DESIGN: Spring 2006 AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■ 5 to the user. We felt the bricks might somehow keep alive a memory of sitting on a back porch at home or walking down the sidewalk in one’s hometown. We contacted the owners and advised them of the potential problems, and we discussed our concerns with Dave McGill of SFCS, an architect on the team who specializes in the pro-gramming and design of senior living facilities. Though he did not believe the inscribing on the bricks would be a problem for Garden users, he was concerned about the bevel in the pavers, and felt that pavers with a ninety degree edge would be safer. The owners consented to eliminating the bevel, at a slightly increased cost per brick, which created a safer, more fluid walking surface for the residents. By effectively communicating with all members of the project team and closely examining every aspect of the design, the design team created a safe, functional and appealing space that will enrich the lives of Lakewood Manor’s residents and Memory Garden visitors. Nathan S. Gruver, Associate ASLA is employed by Timmons Group, a diversified design consulting firm in Richmond, Virginia. He can be reached at HEALING ENVIRONMENTS MASTER PLANNING: A SEAT AT THE TABLE FOR LANDSCAPE ARCHITECTS Laurel Macdonald Bonnell, ASLA Landscape architects have been instrumental in the success and continued acceptance of therapeutic gardens in a variety of healthcare spaces. With current research on the therapeutic benefits of integrating views of nature, plants, and the landscape into medical facility campuses, it is imperative that these healing spaces also achieve a priority in the facility master planning process. Outdoor healing environments need to be included at the preliminary stages of any new facility master plan or medical design project. To accomplish this, landscape architects should be involved at the system-wide master planning stages, through individual campus master planning, as well as in the implementation of site-scale design projects. This early involvement can lead to successful out-door environments, and allows therapeutic gardens to be budgeted for along with other expenditures.
  6. 6. THERAPEUTIC GARDEN DESIGN: Spring 2006 6 In 2004, Samaritan Health Services (SHS), an Oregon based medical service provider, acknowledged the importance of creating healing environments and integrating these spaces into their master planning phases from the beginning stages. Within Samaritan’s seven Oregon campuses, including specialized care facilities, general hospitals, and eldercare, there were already some exceptional existing outdoor spaces. These included vibrant central courtyards, unique gardens incorporating coastal flora, rose gardens, and quiet places for contemplation. There was also a good amount of undeveloped space, making the gardens small islands of success amid an overall substan-dard campus landscape. The development of the Healing Environments Master Plan involved input from facility representatives, patients, and main-tenance staff and administration. The Samaritan Integrative Medicine Committee, a system-wide group of doctors, staff, and administrators focused on expanding traditional approaches to healthcare, served as the meeting point and communication hub. A detailed questionnaire was distributed to as many different users as possible, and eighty were returned. The questions were crafted to gain information on the conditions of the existing campuses, and analyzed how users’ needs and wants could be met in an ideal campus environment. Many of the survey results were predictable, such as requests for more outdoor seating, but other observations came out in the process, such as the desire for better signage and wayfinding. A need for separate staff respite areas was also addressed from questionnaire results. The foundation of the SHS Healing Environments Master Plan was the development of a system-wide definition of a Healing Environment, and using this as a foundation for all future work: SHS Healing Environments Philosophy Each of the Samaritan Health Services Facilities incorporates healing principles into the environment, ensuring the presence of tranquility, beauty, comfort, and safety for the benefit of patients, families, visitors and staff. The development and acceptance of the philosophy proved a powerful unifying element in the process. The system-wide master plan built on the philosophy that SHS is a connected system and that the provision of healing environments should be incorporated into the fabric of administration. Different garden types were outlined in the master plan, along with different types of outdoor healing environments, including meditation gardens, healing gardens, outdoor dining areas, front entry landscape, private areas, and recreation spaces. The range of opportunities encouraged an approach that was more holistic, rather than lobbying for the development of single garden spaces. While master planning is an important process, the document can end up sitting on a shelf somewhere. SHS made a concerted effort to keep the plan philosophy alive while planning subse-quent expansions. They factored campus landscape planning and design into the overall budget plans for new campus facili-ties to ensure that healing environments would be built and funded as planned. Along with identifying which phase of building projects each landscape area should be tied to, the master plan identified a list of components that correspond with each defined landscape garden treatment type. Basic items, such as tables and benches, were included for general land-scaping, while additional amenities such as art, water features, and special paving, were alloted for special areas. This type of detailed planning will ensure that adequate budgets will be planned and allocated for each area. The master plan will provide consistency with each new project, regardless of the designer. The details will help guide future campus development to fit each new piece within the greater whole, keeping overall consistency with furnishings, types and spacing of street trees, and plant materials. Design involve-ment at the planning stage allows for a more consistent, holistic approach, with adequate funding and institutional support. Laurel Macdonald Bonnell, ASLA is Principal Landscape Architect at Macdonald Environmental Planning in Portland, Oregon. The firm specializes in sustainable design, healing environments, and creating communities through-out the Pacific Northwest. She can be reached at THE HEALING GARDEN AT PROVIDENCE HOSPITAL Lydia Stone Kimball, ASLA Providence Hospital, a Catholic hospital located in Northeast Washington, DC, was founded in 1861 by the Daughters of Charity of St. Vincent de Paul. At Providence Hospital, with its commitment to community care in a first-rate facility, more babies of poor mothers have been delivered than at any other hospital in the area. The simple mission to serve patients,families and staff with ‘Joy, Care, and Respect’ applies to all aspects of this healthcare network. As the Hospital grew, the administration remained focused on its overall mission, but the stresses of the modern healthcare environment became increasingly evident. Concerns about staff retention, sicker patients, insurance limitations, and other chal-lenges became more and more prevalent. In response to these concerns, the Hospital Morale Initiative was developed to pro-vide programs for the benefit and support of staff so they could continue to provide top quality care within this challenging environment while maintaining the goals of the mission. In 2000 the hospital expanded its services with a new surgical wing and parking garage. The administration felt the impor-tance of developing a spiritual refuge at the same time—a place to find comfort, pray, and begin healing. The Hospital Morale Initiative embraced the idea of a Healing Garden, to provide a retreat from the relentless rigors and stresses of medicine for all members of the hospital family. The TKF Foundation in Annapolis, MD, the Prince Charitable Trusts, and the Hospital Women’s Board all provided money or other support in order to make this new garden a reality. A site adjacent to the main entrance was selected by the admin-istration. This was a location that was currently undeveloped, available, and would allow the garden to be visible to everyone coming to the hospital. However, it was also a site that would require extensive privacy screening from the public sidewalk and parking area on one side, and first floor office windows on the other. With this very accessible location, however, the garden AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■
  7. 7. THERAPEUTIC GARDEN DESIGN: Spring 2006 In the end, a garden emerged that invites staff, visitors, and patients to experi-ence ‘Joy, Care, and Respect’ in their daily activities and to renew their spir-its for whatever joyfulness or chal-lenges they face. AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■ 7 would be easily available for staff and families, even if they had only a few moments to spend there or were simply passing through. The design concept for the garden focused on creating a series of separate, restorative spaces that would be spiritually, if not physically, “away” from the stressful hospital environment, by providing a connection to growing plants, moving water, and the changing seasons. The design concept was inspired by the observation that the hospital experience—from the perspective of patients, families, or staff—is much like a journey to be traveled: an experience that may have several points of entry, unknown hurdles, a variety of ways through, and reflective moments of peace and beauty. Multiple pathways allow visitors to walk directly through the garden, or to choose narrow step stone paths that bypass the main walks. Both entrances lead to the central fountain area that is shielded from immedi-ate view by stone walls (an obstacle). The idea was for all visitors to encounter an “unknown” and then discover a “refuge” that would provide a place of comfort. The refuge, while central to the garden layout, is only entered by choice, and the paths on both sides allow visitors to walk in, or pass by without intruding on another visitor. The calming nature of water is central to the concept of a healing garden and was there-fore placed here in the heart of the garden. Joy The entrances to the garden are marked with small urns of gently bubbling water. An open lawn area provides unprogrammed space where waiting families with children can spread out. As the largest open space in the garden, and surrounded on all sides by bluestone paving, this lawn area also provides a venue for planned activities, including lunchtime classes, concerts, and Tai Chi demonstrations. Stone walls enclose a central seating refuge featuring three scuppers spilling water into a shallow pool. Step stone paths wind through sunny and shady areas and include additional benches. Planting throughout the garden includes all four seasons of interest: Holly, Beautyberry, Hydrangea, Witchhazel, Summersweet, Peonies, Forget-Me-Not, Ajuga, spring Crocuses, and many other species with carefully consid-ered forms, textures, and patterns. In one location for instance, a River Birch, Oakleaf Hydrangea, Weeping Yew, pachysandra and yellow daylilies combine for a rich blend of peeling bark, spring and summer flowers, evergreen needles, and fall colors. Most of the plants selected are used commonly in residential gardens, and would be familiar to hospital visitors. Care Although highly public, the various garden areas and sensitively arranged seating provide abundant ways for people to use the garden privately. Family clusters, individual reflection, or pro-fessional consultations can be accommodated with benches arranged so that they do not intrude on one another. Alternate paths allow visitors to walk through the garden without neces-sarily passing in front of someone else. The paths and seating areas offer sun or shade, soft or hard surfaces, open space or quiet nooks, proximity to activity or places to be separate. Along the building, combinations of evergreen and deciduous plantings allow views out of the ground floor offices, while still maintaining privacy for those within the garden spaces. Many of the species selected have berries or flowers that attract birds and butterflies, and these are placed so that they are visible from the windows as well. Benches supplied by the TKF Foundation integrate journals into the seats, and visitors are free to write their thoughts in them. It is clear from these entries that people prize the privacy, solace, and spiritual nourishment found in this comforting environment. Respect The garden is fully accessible and open to the public. A stone pier at the east entrance announces the garden. While the garden is fenced along the street and sidewalk, it is not gated. The fence itself, in fact, became a specific design element. An open picket allows views into the garden from the adjacent sidewalk, but other issues were important as well. Brick piers at intervals along the fence line bring the existing architectural material out to the street. The administration requested the garden include the names of all members of the hospital family—groups who have influ-enced or been helped by the hospital. Our solution was to add brass plaques to the outside of each pier, which allowed us to limit the text inside the garden to only the three words of the Hospital’s mission and provide a very public venue for the cele-bration of these important groups. The plaques are evident to all visitors whether or not they enter the garden. The Healing Garden evolved through a collaborative effort of design professionals, hospital administrators, and all levels of staff. From the earliest design meetings, we conferred with not only the leaders of the hospital, but the healthcare providers themselves, to create spaces that would support the caring envi-ronment Providence provides. We discussed in depth issues such as smoking in the garden (no), whether or not food would be allowed (yes), gates or no gates (no gates), who would use the garden (anyone), the kinds of plants to include, sounds in the garden, and how it was to be maintained. In the end, a garden emerged that invites staff, visitors, and patients to experience ‘Joy, Care, and Respect’ in their daily activities and to renew their spirits for whatever joyfulness or challenges they face. These words are carved in stone within the Healing Garden at Providence Hospital. The Garden continues to be a source of inspiration for the hospital, and for our subsequent design work. Note: The garden area is approximately 9100 SF; total cost, approximately $300,000 ($33.00/sf +/-). Lydia Stone Kimball, ASLA is an Associate Principal with Mahan Rykiel Associates in Baltimore, Maryland. She has a special interest in healthcare facilities, senior living projects, and private landscapes. She can be reached at
  8. 8. THERAPEUTIC GARDEN DESIGN: Spring 2006 AMERICAN SOCIETY OF LANDSCAPE ARCHITECTS 636 Eye Street, NW, Washington, DC 20001-3736 ■ Tel 202-898-2444 ■ Fax 202-898-1185 ■ 8 SAMPLE OF ENTRIES FROM JOURNALS MADE AVAILABLE TO VISITORS AT THE PROVIDENCE HOSPITAL HEALING GARDENS “What a lovely place to visit and relax a minute before heading home from a busy night in the ER! Please God, help me make a difference in those whose lives I’ve touched.” “What a wonderful surprise—the Healing Garden! Just what I needed for the lifting of my spirit. Thank God for the creative expression found here.” “The healing garden and the waterfall are beautiful. It’s a nice place to sit on your lunch break to get peace of mind during the workday.” “This small place could as easily not be here just asphalt in front of the hospital. Its powerful presence, speaks in everyone’s notes. It is a place where those troubled can sit, just sit and discover some peace. Peace is found where silence abounds. A tired mind focuses and lays down its burdens.” “I like the way the garden looks and the garden is beautiful too. I was born here in this hospital in the year 1993. I am 8 years old.” Providence Hospital site Providence Hospital Healing Garden Providence Hospital Healing Garden fountain PHOTO: COURTESY OF MAHAN RYKIEL ASSOCIATES PHOTO: COURTESY OF MAHAN RYKIEL ASSOCIATES PHOTO: COURTESY OF MAHAN RYKIEL ASSOCIATES BEFORE AFTER